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CC BY-NC-ND 4.0 · AJP Rep 2024; 14(02): e106-e110
DOI: 10.1055/a-2275-9482
Case Report

Group B Streptococcus Brain Abscess in a Neonate with Bilateral Otorrhea

Emily E. Spencer
1   Department of Pediatrics, Wright State University Boonshoft School of Medicine, Fairborn, Ohio
,
Sarah Van Nostrand
2   Department of Neonatal-Perinatal Medicine, Wright State University Boonshoft School of Medicine, Dayton Children's Hospital and Pediatrix Neonatology of Ohio, Dayton, Ohio
,
Shreyas Arya 
2   Department of Neonatal-Perinatal Medicine, Wright State University Boonshoft School of Medicine, Dayton Children's Hospital and Pediatrix Neonatology of Ohio, Dayton, Ohio
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Abstract

Introduction Group B streptococcus (GBS) is the leading cause of bacterial sepsis and meningitis in neonates worldwide, but brain abscess secondary to GBS is extremely rare. While temporal brain abscesses have been described as a sequelae of otogenic infections in children and adults, such a presentation has not been described in neonates.

Case Description An 8-day-old female infant presented with a fever and irritability along with bilateral purulent otorrhea. Maternal GBS screening was negative, but the delivery was complicated by chorioamnionitis. Workup revealed neutrophilic pleocytosis in the cerebrospinal fluid and culture of the ear drainage was positive for GBS. Magnetic resonance imaging showed a circular lesion with rim enhancement within the left temporal lobe concerning for an abscess. The infant was treated with 14 days of intravenous vancomycin, cefepime, and metronidazole followed by 10 weeks of intravenous ampicillin. The hospital course was complicated by seizures and obstructive hydrocephalus requiring multiple neurosurgical interventions.

Conclusion Brain abscess can occur as a sequela of GBS meningitis in neonates, but they are rare. Otogenic infections require prompt evaluation and treatment as they can progress to serious central nervous infections in neonates.

Keywords

group B streptococcus - neonate - brain abscess - meningitis - otorrhea


Publication History

Received: 07 January 2024

Accepted: 19 February 2024

Accepted Manuscript online:
26 February 2024

Article published online:
04 April 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Stevens JP, Eames M, Kent A, Halket S, Holt D, Harvey D. Long term outcome of neonatal meningitis. Arch Dis Child Fetal Neonatal Ed 2003; 88 (03) F179-F184
    CrossrefPubMedGoogle Scholar
  • 2 Libster R, Edwards KM, Levent F. et al. Long-term outcomes of group B streptococcal meningitis. Pediatrics 2012; 130 (01) e8-e15
    CrossrefPubMedGoogle Scholar
  • 3 Gaschignard J, Levy C, Romain O. et al. Neonatal bacterial meningitis: 444 cases in 7 years. Pediatr Infect Dis J 2011; 30 (03) 212-217
    CrossrefPubMedGoogle Scholar
  • 4 Heath PT, Nik Yusoff NK, Baker CJ. Neonatal meningitis. Arch Dis Child Fetal Neonatal Ed 2003; 88 (03) F173-F178
    CrossrefPubMedGoogle Scholar
  • 5 Mosayebi Z, Mohammadi M, Mohammadi M, Jafari A, Movahedian AH. Early-onset meningitis with group b streptococcus: the case of a female neonate with brain abscess in Iran. J Compr Pediatr 2017; 8 (04) e12899
    PubMedGoogle Scholar
  • 6 Puopolo KM, Lynfield R, Cummings JJ. Committee on Fetus and Newborn, Committee on Infectious Diseases. Management of infants at risk for group B streptococcal disease. Pediatrics 2019; 144 (02) e20191881
    CrossrefPubMedGoogle Scholar
  • 7 Verani JR, McGee L, Schrag SJ. Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC). Prevention of perinatal group B streptococcal disease–revised guidelines from CDC, 2010. MMWR Recomm Rep 2010; 59 (RR-10): 1-36
    PubMedGoogle Scholar
  • 8 Ouchenir L, Renaud C, Khan S. et al. The epidemiology, management, and outcomes of bacterial meningitis in infants. Pediatrics 2017; 140 (01) e20170476
    CrossrefPubMedGoogle Scholar
  • 9 Unhanand M, Mustafa MM, McCracken Jr GH, Nelson JD. Gram-negative enteric bacillary meningitis: a twenty-one-year experience. J Pediatr 1993; 122 (01) 15-21
    CrossrefPubMedGoogle Scholar
  • 10 Kuzniewicz MW, Puopolo KM, Fischer A. et al. A quantitative, risk-based approach to the management of neonatal early-onset sepsis. JAMA Pediatr 2017; 171 (04) 365-371
    CrossrefPubMedGoogle Scholar
  • 11 Rocchetti TT, Marconi C, Rall VLM, Borges VTM, Corrente JE, da Silva MG. Group B streptococci colonization in pregnant women: risk factors and evaluation of the vaginal flora. Arch Gynecol Obstet 2011; 283 (04) 717-721
    CrossrefPubMedGoogle Scholar
  • 12 Baltimore RS. Consequences of prophylaxis for group B streptococcal infections of the neonate. Semin Perinatol 2007; 31 (01) 33-38
    CrossrefPubMedGoogle Scholar
  • 13 Prevention of Group B Streptococcal Early-Onset Disease in Newborns. Accessed December 9, 2023 at: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2020/02/prevention-of-group-b-streptococcal-early-onset-disease-in-newborns
    PubMed
  • 14 Nanduri SA, Petit S, Smelser C. et al. Epidemiology of invasive early-onset and late-onset group B streptococcal disease in the United States, 2006 to 2015: multistate laboratory and population-based surveillance. JAMA Pediatr 2019; 173 (03) 224-233
    CrossrefPubMedGoogle Scholar
  • 15 Van Dyke MK, Phares CR, Lynfield R. et al. Evaluation of universal antenatal screening for group B streptococcus. N Engl J Med 2009; 360 (25) 2626-2636
    CrossrefPubMedGoogle Scholar
  • 16 Berardi A, Trevisani V, Di Caprio A. et al. Understanding factors in group B streptococcus late-onset disease. Infect Drug Resist 2021; 14: 3207-3218
    CrossrefPubMedGoogle Scholar
  • 17 Berardi A, Rossi C, Lugli L. et al; GBS Prevention Working Group, Emilia-Romagna. Group B streptococcus late-onset disease: 2003-2010. Pediatrics 2013; 131 (02) e361-e368
    CrossrefPubMedGoogle Scholar
  • 18 Ren J, Qiang Z, Li YY, Zhang JN. Biomarkers for a histological chorioamnionitis diagnosis in pregnant women with or without group B streptococcus infection: a case-control study. BMC Pregnancy Childbirth 2021; 21 (01) 250
    CrossrefPubMedGoogle Scholar
  • 19 Ku LC, Boggess KA, Cohen-Wolkowiez M. Bacterial meningitis in infants. Clin Perinatol 2015; 42 (01) 29-45 , vii–viii
    CrossrefPubMedGoogle Scholar
  • 20 Hristeva L, Booy R, Bowler I, Wilkinson AR. Prospective surveillance of neonatal meningitis. Arch Dis Child 1993; 69 (1 Spec No): 14-18
    CrossrefPubMedGoogle Scholar
  • 21 Renier D, Flandin C, Hirsch E, Hirsch JF. Brain abscesses in neonates. A study of 30 cases. J Neurosurg 1988; 69 (06) 877-882
    CrossrefPubMedGoogle Scholar
  • 22 Giannattasio A, Raimondi F, D'Amico A, Lama S, Spagnuolo MI. Late-onset brain abscess due to group B Streptococcus. Case Rep Perinat Med 2016; 5 (02) 165-167
    CrossrefPubMedGoogle Scholar
  • 23 Pasternak JD, Fulford M, Gunnarsson T, Provias J, Singh SK. An unexpected intracranial pressure crisis: infant brain abscess of unusual aetiology. Childs Nerv Syst 2009; 25 (03) 377-381
    CrossrefPubMedGoogle Scholar
  • 24 Duarte MJ, Kozin ED, Barshak MB. et al. Otogenic brain abscesses: a systematic review. Laryngoscope Investig Otolaryngol 2018; 3 (03) 198-208
    CrossrefPubMedGoogle Scholar
  • 25 Metcalf BJ, Chochua S, Gertz Jr RE. et al; Active Bacterial Core surveillance team. Short-read whole genome sequencing for determination of antimicrobial resistance mechanisms and capsular serotypes of current invasive Streptococcus agalactiae recovered in the USA. Clin Microbiol Infect 2017; 23 (08) 574.e7-574.e14
    CrossrefPubMedGoogle Scholar
  • 26 Nau R, Sörgel F, Eiffert H. Penetration of drugs through the blood-cerebrospinal fluid/blood-brain barrier for treatment of central nervous system infections. Clin Microbiol Rev 2010; 23 (04) 858-883
    CrossrefPubMedGoogle Scholar
  • 27 Sheehan JP, Jane JA, Ray DK, Goodkin HP. Brain abscess in children. Neurosurg Focus 2008; 24 (06) E6
    CrossrefPubMedGoogle Scholar
  • 28 Goodkin HP, Harper MB, Pomeroy SL. Intracerebral abscess in children: historical trends at Children's Hospital Boston. Pediatrics 2004; 113 (06) 1765-1770
    CrossrefPubMedGoogle Scholar